As a first time mom, being a pediatric physical therapist was honestly really tough to navigate. I’m a very empathetic person by nature (honestly to the extent that it can be pretty debilitating at times), and I obviously always felt my heart go out to the children and families I had the honor of working with. But being pregnant for the first time hit me with a level of anxiety I REALLY did not see coming, and though I didn’t realize it at the time, it truly infiltrated every area of my life, from personal to professional and everything in between.

Throw in gestational hypertension, a LONG labor, and a delivery that ended in shoulder dystocia, respiratory distress and a NICU stay for my oldest - and a hemorrhage for me and it was just….incredibly hard, and without question a huge contributor to my struggle with postpartum anxiety and overall mental health. I felt so incredibly alone, even when surrounded with support and love - so I wanted to share my journey and perspective as both a pediatric physical therapist AND mom in the

hopes it reaches someone else who may need the solidarity as much as I did.

Our NICU experience

When I was around 28 weeks pregnant at a regular OBGYN check up, we noticed my blood pressure starting to creep up. It wasn’t alarming at the time, but something we were watching closely - and unfortunately, it continued to creep upwards each appointment. Thankfully, it didn’t turn into more than gestational hypertension, but it did result in an early induction at 37.5 weeks, after a few particularly concerning readings in a row and a small amount of protein in my urine (which is indicative of the beginnings of pre-eclampsia). Side note - If I never have to use one of those dang 24 hour pee collection jugs again, it’ll be too soon 😂 IYKYK.

So, 37.5 weeks, already very anxious - and now en route to be induced straight from my OBGYN’s office. I was…a worried mess to say the least.

My induction began and was fairly uneventful for awhile….my water broke, contractions ramped up, labor progressed and eventually, I asked for an epidural. Epidural was placed, labor progressed and then, it was time to push.

This is where everything started to fall apart and to be honest, my recollection of parts of this is still pretty fuzzy -

I remember them telling me to push, and I went to memories of swimming in the pool with my brother where we would try to hold our breath underwater all the way from one side to the other. I channeled my breathing, pushed about 3 times, and she was on her way! And then - the OB told me not to push and I heard her say ‘McRobert’s’, to the nurse, and I knew right away Audrey was stuck and they were worried about shoulder dystocia. It all happened SO quickly after that - Audrey was out and crying, they placed her on my chest briefly - and the next thing I knew, the OB hit the big red ‘oh sh*t’ button over my head and the room was SWARMED with nurses and doctors. Audrey was taken off my chest and had gone into respiratory distress, on top of them needing to X-ray her arm due to the dystocia and I was hemorrhaging.

In all honesty, I really don’t remember much except looking at Jay and seeing the fear in his eyes - for me, and for her - and him telling my mom and sister to go with her as she was transported to the NICU because he wasn’t leaving me. After that, everything is fuzzy and I woke up hours later PANICKED because I didn’t know where Audrey was or what had happened.

In hindsight - waking up in that panic feels like the catalyst to my postpartum anxiety. I instantly felt I had failed her, I had brought her into the world in the midst of chaos, and my nervous system was on the highest possible alert I’d ever felt. I needed to see her, and it needed to be NOW…

….except she was in the NICU. And it was the middle of the night and closed to visitors, including parents. I will never forget standing at the NICU door looking in, not allowed to go to her and just sobbing. I needed to hold her. I needed to try to nurse her. What was she eating? Was she scared? Crying alone in the incubator? The thoughts crossing my mind were heart breaking and terrifying, and waiting for the NICU to open in the morning felt like the longest few hours of my life.

And then….there she was. In my arms, and safe. And let me be clear - the NICU team was INCREDIBLE. I truly could not have asked for a better team of people to support us in those days - but it wasn’t how our story was supposed to turn out. We weren’t supposed to end up in the NICU. She wasn’t supposed to be taking bottles of formula. And NOT because I’m anti formula (all 3 of my kids had formula at one point or another!)- but I wanted to nurse her. I wanted to pump for her - and I did, but it took MONTHS for us to transition back to solely breast milk. Months of lactation consults, nipple shields, and triple feeding. And again, NOT at the fault of the NICU team, but knowing we hadn’t given permission for her to be given formula was something I carried immense guilt about for a long time. They had very little choice, but to be honest, that didn’t matter to my brain. I felt robbed. I felt robbed of the golden hour. Robbed of the immediate post-delivery experience of feeling her on my chest, robbed of being able to welcome her to the world with me by her side the whole time.

And even more so….I hated the idea of other people holding her, feeding her, changing her diaper. They were wonderful, but it was supposed to be my job. It all just felt so unfair - and then I felt guilty for being so upset when I knew so many other people right next to us in the NICU were going through so much worse and battling such bigger struggles.

Ultimately, we were so fortunate to only need to be in the NICU for 2 days and thankfully she was able to come home with us at discharge, but I would be lying if I said those 2 days didn’t play a major part in shaping the next year of mine and her lives. So if you’re in the NICU right now, have been through your own NICU journey, or are navigating having a premie, I just want you to know I see you. My heart goes out to you, and I hope you know you’re doing a great job - and someday so soon, this will all be a distant memory and you’ll have your sweet babe home and in your arms, right where they belong.

More on Prematurity - When is a Baby Considered Premature? How Do We Look at Milestones for Premies? When Do Premies ‘Catch Up’ to Peers? How Can We Support Them In Doing So?

When is a Baby Considered Premature?

First - let’s just quickly break down prematurity & adjusted age, especially when considering milestone expectations.

A baby is typically considered premature if they are born AT or BEFORE 37 weeks gestation. However in recent years, we’ve become more specific and now consider a baby born before 34 weeks to be ’premature’, and a baby born between 34-37 weeks to be ‘late pre-term’.

When it comes to premies born at or before 36 weeks gestation and milestones, we typically consider their ACTUAL age (the age they truly are) versus ADJUSTED age (their age when considering how many weeks/months premature they were born.)

*Worth noting - though we don’t formally ‘adjust’ for babies born at 37 weeks, I will say without a doubt (after having 3 of my own kids be born at 37 weeks) - they can still use the consideration that they ‘missed out’ on those 3 weeks in utero and may need a little extra time to catch up! I remember being SO worried when they weren’t doing little things in the early weeks I was expecting - like making eye contact, smiling, coo-ing - but for each of them, when I gave them an extra week or two past when those things were expected, they had caught up and were then doing them. Just sharing because I know it would have helped put my mind at ease if I knew others had experienced the same thing, because it truly is so common in those late pre-term kiddos!

How Do We Look at Milestones for Premies? When Do Premies ‘Catch Up’ to Peers? How Can We Support Them in Doing so?

When looking at milestone expectations for babies born premature, we are looking at ACTUAL versus ADJUSTED age.

Actual age Is your child's age from the date of their birth. For example, if they were born in January 3, and it's now currently May 3, their ACTUAL age would be four months old.

Now, let's say this same child was born January 3rd, but was born prematurely, at only 36 weeks gestational age. To account for prematurity, you're essentially ‘crediting’ them the time that they would have been in utero, had they not been born prematurely.

In this example, this baby was born January 3rd, four weeks early. If their ACTUAL age is four months, and you take that four weeks away, you'd be assessing them at a THREE month level. Their ADJUSTED age is three months.

Typically, when I'm evaluating for motor milestones, as mentioned above- this adjustment is made for babies born 37 weeks (considered early term) gestational age and earlier, but there is no hard and fast rule here, so it's truly often up to the professional whether to credit for 37 weeks and 2,3,4,5,6 days. However, in my opinion, it's important to consider regardless because due dates are often an estimate anyway！

When it comes to the expected milestones, should we look at their ACTUAL age or their ADJUSTED age?

I want to be clear- not every premature baby needs the adjustment! Some babies born premature hit their milestones ahead, or right on time for their actual age.

Some need adjustment for some milestones, but not others. Ultimately, adjusted age is a guide that CAN be used for babies born prematurely, if needed. It can be a helpful tool to ease parent's minds as well, because truly - SO much happens every week a baby is in utero, so acknowledging that with our expectations and environment set ups for babies born prematurely can make a world of difference for your little one! For support & resources on navigating milestones, setting up baby’s play space intentionally to foster development, and so much more- be sure to check out our resources here.

How long do we consider their adjusted age when it comes to milestones?

Typically, we consider adjusted age until a child turns two, at which time the hope is that they would have caught up to their peers and the milestone expectations for their actual age have been met. More on prematurity and adjusted age can be found here (Prematurity/Adjusted Age IG post )

I hope this helps if you’re navigating prematurity, a NICU stay, or a little one working through something unexpected - and for tons more tummy time support, check out these resources and some of my absolute favorite items for engaging & connecting with your babe in the early weeks and months!

MORE RESOURCES FOR ENCOURAGING MOTOR DEVELOPMENT IN INFANTS:

Want More Help With Tummy Time?

For developmental questions, tips and guidance related to milestones about tummy time, rolling & sitting, crawling and walking, check out KC’s developmental Masterclasses linked here.

Prematurity, NICU Stays & A Heart to Heart on Our Journey